Infant Feeding Practices And Growth Biology Essay

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Breastfeeding is the normal/natural way of providing young infants ( from birth till 2 years of age) with the nutrients they need to grow and develop properly. Virtually all mothers can breastfeed. They must be provided with accurate information as well as the support of their family, the health care system and society at large. The yellowish, sticky breast milk produced at the end of pregnancy is known as colostrum. It is the ideal food for the newborn. It is strongly recommended to start feeding within the first hour after birth. It should be continued along with appropriate complementary foods up to two years of age or beyond (WHO, 2010). Infants must receive only breast milk for the first 6 months of life with no other lipids (except drugs) or solids (Quigley, 2007, Duggan et al, 1990).

1.2 DURATION OF BREASTFEEDING:

The duration of breastfeeding is critical. It has several effects on a wide array of demographic, maternal and infant health outcomes (Adair et al, 1993). The length of time a woman breastfeeds her infant depends on her personal feelings and situation. According to (AAP, 2005), exclusive breast-feeding is recommended for the first 6 months of life. Nevertheless, this can be continued as long as it is mutually desired by the mother and the child. Some mothers prefer to breastfeed until the baby is weaned to a cup. Others choose to breastfeed much longer, letting the baby decide when to wean. Usually weaning starts around 9 to 10 months (Mahan and Escott-Stump, 2008).

1.3 PHYSIOLOGY OF LACTATION:

Mammary gland growth during menarch and pregnancy prepares for lactation. Hormonal changes markedly increase breast, areola and nipple size in pregnancy. Hormones that significantly increase ducts and alveoli influence mammary growth. At the end of pregnancy, the lobules of the alveolar system are fully developed. Small amount of colostrum which is the thin, yellow, milky fluid rich in antibodies may be released for several weeks before and few days after delivery. There is a rapid drop in circulating levels of estrogen and progesterone accompanied by a rapid increase in prolactin secretion. This sets the stage for a continuous supply of milk.

Suckling is the usual stimulus for continuous milk production and secretion. Subcutaneous nerves of the areola send a message via the spinal cord to the hypothalamus which in turn transmits the message to the pituitary gland. This is where both the anterior and posterior areas are stimulated. Prolactin from the anterior pituitary stimulates alveolar cell milk production. Oxytocin from the posterior pituitary stimulates the myoepithelial cells of the mammary gland to contract. Let-down or "Milk Ejection Reflex "is the process that causes the movement of milk through the ducts and lactiferous sinuses.

Let-down is highly sensitive. Oxytocin, the milk-releasing hormone can be released by visual, tactile, olfactory and auditory stimuli and even by thinking about the infant. Oxytocin secretion can be stopped by pain, emotional and physical stress, fatigue and anxiety. (Lauwers and Shinkie, 2000) stated that adrenaline is believed to contradict the effects of oxytocin on the myoepithelial cells. (Lawrence and Lawrence, 2005) found that women who have diabetes are stressed during delivery. They have retained placental fragments and are at risk of having delayed milk production occurring when signs of lacto-genesis are absent 72 hours after birth (USDA, 2010; Mahan and Escott-Stump, 2008).

Sends message to the brain1.3.1 A SCHEMATIC REPRESENTATION OF HOW MOTHERS MAKE MILK IN FIGURE1:

Nerve endings from the breast

Signals the pituitary glands to release two hormones

Brain

Stimulates muscle cells around alveoli to contract

Causes the alveoli to make milk

Prolactin

Oxytocin

Milk let down for current feed

Milk synthesis and secretion for next feed

Sight of baby, baby's voice, feelings of love and confidence - increase milk production

Anxiety, pains and doubts - lower milk production

More frequent suckling or milk removal - Increase milk production

Poor suckling or milk removal - Lower milk production

1.4 BREAST MILK:

1.4 Breast milk:

1.4 BREAST MILK:

Breast milk is the best food for infants. It is unique in its physical structure. It contains essential types and sufficient concentrations of protein, fat, carbohydrate, vitamins and minerals, enzymes, hormones, growth factors, host resistance factors, inducers and modulators of the immune system and anti-inflammatory agents (USDA, 2010). (Jelliffe, 1975) stated that "Breast milk is considered superior over other modified infant milk formulae owing to its various inherent properties and advantages." (Barrie et al., 1975) found the composition of breast milk to vary greatly among different individuals, from feed to feed and day to day (Sarkar, 2004).

1.5 COMPOSITION OF BREAST MILK:

A Research by (Carias et al., 1997) showed that colostrum is the specialized milk produced for the first few days after delivery. It is yellowish and sticky. Colostrum differs from mature milk in its composition. It is rich in protein and low in fat compared to mature milk. Nevertheless, the energy and carbohydrate content are similar to mature milk. (McClelland et al., 1978) stated that the concentration of protein in colostrum declines at a higher rate in the first week. It then drops little by little during the rest of the lactation period. (Macy et al., 1953) The fat content of breast milk is influenced by the stage of lactation. It tends to increase slightly from colostrum to mature milk after two weeks of lactation. (Carias et al., 1997) suggested that the Iron and calcium content of milk remain unchanged. The amount of Zinc and copper in the milk, respectively decrease and rise with the time of lactation. Moreover, the concentration of phosphorous and magnesium increase up to three months and remain constant afterwards. (Bohm et al., 1997) concluded that vitamins are present in breast milk (Sarkar, 2004).

1.6 BENEFITS OF BREAST-FEEDING:

(Gartner et al., 2005) illustrates that breastfeeding confers gains on both mothers and babies. These include health, immunological, developmental, psychological, social, economic and environmental benefits (Keraney et al, 2010).

1.6.1 INFANT HEALTH BENEFITS:

Nutrition:

A balanced and sufficient nutrition is essential to maintain good health and to lead a good life as it provides the infant with all the nutrients in adequate amount (Memis et al, 2010). One of the advantages of breast-feeding is that it provides optimum nutrition for the infant during the first 4 to 6 months of life (Duggan et al, 1990).

Infant development:

Breastfeeding optimizes neural and psychosocial development of the infant (Cook et al, 2003; Dòrea, 2009). This is because the nutrients found breast milk meet the dietary requirements of the baby, thereby ensuring proper growth and development of the baby.

Immunological protection:

Breast-feeding enhances the infant's immune system by identifying and destroying foreign objects such as bacteria and viruses (Duggan et al, 1990, Berg et al, 1984). According to (Prentice, 1996), breast milk contains immunoglobulin lgA and lgG which protect the infant against diseases.

Asthma and wheeze:

'Asthma is a heterogeneous syndrome characterized by variable, reversible airway obstruction and abnormally increased responsiveness (hyper-reactivity) of the airways to various stimuli.' The syndrome is categorized by wheezing, chest tightness, dyspnea, and/or cough. It comes from from widespread contraction of tracheobronchial smooth muscle (bronchoconstriction), hyper-secretion of mucus, and mucosal edema. These narrow the caliber of the airways (Henry Gong, 1990).

A study by (Dell et al, 2001) concluded that the length of time which a child is breast-fed, the more preventive it is against asthma and wheeze. However, (Holloway et al, 2001; Gahagan, 2007) did not find any association between breastfeeding and asthma.

Cardiovascular Diseases (CVDS):

'Cardiovascular disease (CVD) is an abnormal function of the heart or blood vessels.' It makes people prone to heart attack, heart failure, sudden death, stroke and cardiac rhythm problems. Its effect is a decrease in quality of life as well as a lowered life expectancy. Its risk factors include high blood pressure, high cholesterol, excess weight, physical inactivity, smoking, diabetes, excessive alcohol consumption, illegal drug use and stress (CVDF, 2009).

Human milk contains hormones and growth factors that play a crucial role in the development of the cardiovascular system. Infant breastfeeding has been associated with lower levels of cardiovascular risk factors in childhood (Rich-Edwards et al, 2004). Breast-feeding was associated with an elevated risk of coronary heart disease (Elwood et al, 2005).

Diabetes:

'Diabetes is a disease in which your blood glucose, or sugar, levels are too high.' Glucose is obtained form the food consumes. Insulin is a hormone that aids the glucose get into your cells to give them energy. With Type 1 diabetes, the body does not manufacture insulin. With Type 2 diabetes, your body does not either make or use insulin properly. Without enough insulin, the glucose remains in the blood. When the glucose level in the blood becomes too high, serious problems are bound to happen. It can damage the eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even limb amputation. Pregnant women can also get diabetes, called gestational diabetes. Symptoms of Type 2 diabetes are fatigue, thirst, weight loss, blurred vision and frequent urination. Some people have no symptoms. Diabetes can be diagnosed by a blood test. Exercise, weight control and sticking to your meal plan can help control the diabetes. Glucose level must be monitored. Medicine must be taken if prescribed.

Breast-fed infants have lower insulin levels than bottle-fed infants. They confer better glucose tolerance and lowered risk of diabetes mellitus (Rich-Edwards et al, 2004, Brudenell et al, 1995). As cited by (Harris, 2005; Sloka et al., 2008), type 1 diabetes mellitus (T1DM) is among the most prevalent chronic diseases which begins in childhood. It is being the second most common chronic disease in children after asthma in the USA. It arises from an immune-mediated damage of pancreatic insulin-producing b-cells, with both genetic and environmental factors playing roles in the aetiology. It is linked about 60 per cent to genes in the human leukocyte antigen (HLA) complex of the main histocompatibility complex (MHC) on chromosome 6p21 ( Karabouta et al, 2010).

Respiratory Syncytial Virus Infections:

Respiratory syncytial virus infection (RSV) very much resembles a bad cold. It has the same symptoms like a cough, a stuffy or runny nose, a mild sore throat, an earache and a fever. Babies with RSV may have no energy, act fussy or cranky and be less hungry than usual. Wheezing may occur in extreme cases. It is very contagious. The majority of children have had it at least once by age 2 (WebMD, 2005-2011).

Epidemiological evidence reported that breast-feeding protects against infection with respiratory syncytial (RS) virus. It is the most important respiratory pathogen in infancy (Downham et al, 1976).

Wilms tumor:

'Wilms tumor is a type of kidney cancer that occurs in children.' Its exact cause is unknown. A missing iris of the eye (aniridia) is a birth defect that is often associated with Wilms tumor. Other birth defects consist of certain urinary tract problems and enlargement of one side of the body, a condition called hemi-hypertrophy. The disease occurs in about 1 out of 200,000 to 250,000 children. It generally attacks when a child is about 3 years old. It hardly develops after age 8. Its symptoms are abdominal pain, constipation, fever, loss of appetite, nausea, welling in the abdomen and vomiting (NCBI, 2011).

(Breslow et al, 2006) suggests an association between breast-feeding and wilms tumor.

Myopia:

Nearsightedness, or myopia is a medical term used for a vision condition in which close objects are seen clearly, but objects farther away appear blurred. Nearsightedness occurs if the eyeball is too long or the cornea which is the clear front cover of the eye has too much curvature. Therefore, the light entering the eye isn't focused correctly. Distant objects look blurred. It is mainly caused due to heredity and visual stress (AOA, 2006-2011).

Breastfeeding was independently associated with decreased likelihood of myopia provided that risk factors are controlled. Breast milk is the main source of many micronutrients including docosahexaenoic acid, which is crucial for photoreceptor and cortical neuronal development (Chong et al, 2005).

Leukemia:

'Leukemia is a malignant disease (cancer) of the bone marrow and blood.' It is described by the uncontrolled accumulation of blood cells. Its symptoms consist of tiredness , shortness of breath during physical activity, pale skin, slow healing of cuts and excess bleeding, black-and-blue marks (bruises) for no clear reason, pinhead-size red spots under the skin, low white cell counts, especially monocytes or neutrophils (LLS, 2011).

The (National Cancer Institute, 2004) claim that leukemia is the most frequent childhood malignancy. It has an annual incidence rate of 4.5 cases per 100,000 children aged 0-14 years. (Athanassiadou et al, 2008). Studies supported the fact that breast-feeding offers protection against leukemia (Abrams et al, 2004). (Greeves, 2002; Beral et al., 2001) also agree with the above statement that breast-feeding lowers the risk of childhood leukemia (Athanassiadou et al, 2008).

Allergy:

'An allergy is an abnormal reaction by your body to things that it is sensitized to.' An allergen causes an allergy. Symptoms of allergy consist of itchy watery eyes, itchy runny nose, itchy skin, eczema, hives, dark circles under and around the eyes, shortness of breath and stomach cramps (Canadian lung Association, 2010).

Breastfeeding has a protective effect against allergy (Cook et al, 2003). Another study claims that breast-feeding has nothing to do with the prevention of Allergy (Gahagan, 2007).

Blood pressure:

'Blood pressure is the pressure of the blood against the walls of the arteries'. It results from two forces. One is created by the heart as it pumps blood into the arteries and through the circulatory system. The other one is the force of the arteries as they resist the blood flow. It is a silent killer and does not show any symptoms (AHA, 2011).

A study by (Rich-Edwards et al, 2004) did not show any association between breast-feeding and hypertension. Another research suggested that breast-feeding has a modest effect on blood pressure (Cook et al, 2003).

Gatroenteritis:

'Gastroenteritis is an infection of the gut'. This infection arises from eating or drinking food that is contaminated with bacteria, viruses or parasites, or from other people with an infection. Bacteria, viruses and parasites may destroy the cells lining the inner surface of the gut and prevent it working as it should. Its symptoms comprise of diarrhea, which may contain blood and mucus, or be watery, greasy or frothy, abdominal (tummy) cramps, bloating or pain and a fever (BUPA, 2010).

Breast-fed babies are more resistant to gastroenteritis than Infant Formula-fed babies. This is due to the passive transfer of antibodies to enteropathogenic E. coli in colostrum (Sussman, 1961), contamination of artificial feeds during preparation (Neter, 1959), and the nature of the intestinal environment (Ross and Dawes, 1954). In a more detailed study of the problem, Ross and Dawes concluded that the most important factors responsible for natural resistance to enteric infections were the preponderance of lactobacilli in the faeces of breast-fed infants and the relatively low pH of the large bowel content. They found that oral feeds of lactose had only a partial and temporary effect in reducing the pH of the faeces of artificially fed babies. They suggested that human milk must contain another component that is needed to maintain an acid pH and a lactobacillary flora (Bullen et al, 1971).

Infectious disease like Diarrhea and Campylobacteriosis:

'Diarrhea can be described as an abnormal increase in the frequency, volume or liquidity of your stools'. This condition lasts from a few hours to a couple of days. Viruses, bacteria and parasites cause diarrhea. Medications like antibiotics disturb the natural balance of the bacteria in your intestines causing diarrhea. Frequent loose, watery stools, abdominal cramps, abdominal pain, fever, bleeding and dizziness from dehydration are symptoms of diarrhea (UCSF, 2002-2011).

(Fuchs et al., 1996) showed that infants fed with breast milk have little probability of dehydrating diarrhea. According to (Adeyemo et al., 1997), Bloody diarrhea occurred less frequently in breast-fed infants (Sarkar, S., 2004).

'Campylobacteriosis is an acute bacterial disease which attacks the digestive system'. A person may become infected by eating undercooked chicken or pork, or drinking contaminated water or raw milk. It may also be contracted from close contact with infected puppies and kittens, farm animals or infected infants. The symptoms may occur from 2-10 days after initial exposure. They are characterized by diarrhea, abdominal pain, malaise, vomiting, fever and nausea. The symptoms can vary from mild to severe (PHAC, 2003).

(Muhammad et al., 1996) said that Breast-feeding has a protective effect against Campylobacter jejuni infection (Sarkar, 2004).

Childhood Obesity:

The problem of childhood obesity in the United States has become alarming in recent years. Between 16 and 33 percent of children and adolescents are obese. Obesity is easy to recognize but very difficult to treat.

Some excessive pounds do not suggest obesity.  However they show a tendency to gain weight easily and a need for changes in diet and/or exercise.  A child is not assumed to be obese until the weight is at least 10 percent higher than what is recommended for the height and body type.  Obesity usually starts in childhood between the ages of 5 and 6. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 percent chance of becoming an obese adult. Genetic, biological, behavioral and cultural factors are the principal causes of obesity.  Basically, it occurs when a person eats more calories than the body burns up.  If one parent is obese, there is a 50 percent chance that the children will also be obese.  However, when both parents are obese, the children have an 80 percent chance of being obese.  Although certain medical disorders can cause obesity, less than 1 percent of all obesity is caused by physical problems. Obesity in Children and adolescence can be associated with poor eating habits, overeating, lack of exercise, family history of medical illnesses (endocrine, neurological problems), medications (steroids), depression or other emotional problems. The risks and complications of obesity include increased risk of heart disease, high blood pressure, diabetes and breathing problems (AACAP, 2010). Estimates suggested that the prevalence of overweight and obesity in all age groups is rapidly increasing worldwide. In Australia approximately 25% of children are overweight or obese and that estimate is growing with data highlighting that these increases begin in early childhood. The prevalence ranges from 16.3 to 27.2 per cent in girls and from 13.4 to 21.4 per cent in boys between 1995 and 2002 (Ball et al, 2008).

Breastfeeding was found to safeguard against childhood obesity (Rich-Edwards et al, 2004, Cook et al, 2003). (Koletzco, 2006) also added that breast-feeding more than 6 months lowers the risk of obesity by more than 25% .

1.6.2 BENEFITS TO MOTHERS:

Breastfeeding and child spacing:

A research by (Duggan et al, 1990; Millman and Cooksey, 1987; Davanzo et al, 1985) showed that breastfeeding delays ovulation which acts as a contraceptive effect. This is caused by the hormone prolactin, which is higher in breastfeeding women compared to that of non- breastfeeding ones. Those women who breast-feed over longer periods of time have lower fertility compared to those who carry out irregular suckling. According to (NRDC, 2005), breast-feeding is a form of birth control found to be 98 percent more effective than a diaphragm or condom. In Africa and in Bangladesh, breastfeeding prevents an estimated average of four and 6.5 births per woman respectively.

Cancer:

'Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues'. Cancer cells can proliferate to other parts of the body through the blood and lymph systems. Different types of cancers exist (NCI, 2010).

Ovarian cancer:

Ovarian cancer is cancer that affects the ovaries. Obesity, cigarettes smoking and long term Hormone replacement therapy are risk factors of ovarian cancer (NBOCC, 2010).

The risk of suffering from ovarian cancer is reduced when a woman breastfeeds her infant (Duggan et al, 1990). This is because ovulation stops or occurs less often in breastfeeding woman. Some experts believe that women who ovulate less often have a decreased risk of ovarian cancer (FCCC, 2009).

Breast cancer:

'Breast cancer is a malignant tumor that starts from cells of the breast'. A malignant tumor is a group of cancer cells that may invade the surrounding tissues or proliferate to distant areas of the body (ACS, 2010).

A woman is protected from breast cancer when she breastfeeds her infant (Duggan et al, 1990). About 46,000 women get breast cancer in the UK yearly. Most of them (8 out of 10) are over 50. Younger women in rare cases men can also get breast cancer (NHS, 2010).

Post-partum weight loss:

Breast-feeding promotes post-partum weight loss (Brudenell et al, 1995). This is explained by the fact that mothers burn many calories during lactation as their bodies produce milk. In fact, some of the weight gained during pregnancy serves as an energy source for lactation (NRDC, 2005).

Economy:

When a mother breastfeeds her child, she does not need to buy cow's milk or infant formula for her baby. This enables her to save some money (Duggan et al, 1990). It also avoids medical bills afterwards as it equips the baby to fight off disease and infection. A research showed that a group of formula-fed infants had $68,000 in health care costs in a six-month period while an equal number of nursing babies had only $4,000 of similar expenses (NRDC, 2005).

Bonding of mother with child:

The emotional health of the mother may be enhanced by the relationship she develops with her infant during breastfeeding. This results in fewer feelings of anxiety and a stronger sense of connection with her baby (NRDC, 2005; Duggan et al, 1990).

Prevents the mother from losing blood:

Post-partum uterine contractions stimulated in the mother make her lose less blood. This is because the infant's sucking makes the uterus contract (USDA, 2010).

1.7 Cow's milk:

(Swaminathan, 1998) found that the considerable amount of casein present in animal's milk forms a dense curd in the stomach of infants when acted upon by pepsin. The digestion of pepsin is delayed by the neutralization of the hydrochloric acid present in the gastric juice by buffer salts. Swaminathan (1998) also suggested that if buffalo milk has to be used, then it must be partially skimmed or toned by addition of an equal amount of reconstituted skimmed milk or diluted with water (Sarkar, 2004).

1.7.1 Composition of human and cow's milk:

Content

Human milk

Cow's milk

Total Fat (g/100 ml)

4.2

3.8

Fatty acids � 8C (% )

trace

6

Polyunsaturated fatty acids (%)

14

3

Total Protein (g/100 ml)

1.1

3.3

Casein 0.4

0.3

2.5

-lactalbumin

0.3

0.1

Lactoferrin

0.2

trace

-lactalbumin

0.3

0.1

Lactoferrin

0.2

trace

IgA

0.1

0.003

IgG

0.001

0.06

Lysozyme

0.05

trace

Serum albumin

0.05

0.03

β-lactoglobulin

-

0.3

Total Carobohydrate (g/100 ml)

-

-

Lactose

7.0

4.8

oligosaccharides

0.5

0.005

Total Minerals (g/100 ml)

-

-

Calcium

0.030

0.125

Phosphorus

0.014

0.093

Sodium

0.015

0.047

Potassium

0.055

0.155

Chlorine

0.043

0.103

Table 1.1: Nutritional composition of human and cow's milk

Source: (Prentice, 1996) http://unu.edu/unupress/food/8F174e/8F174E04.htm

Breastfeeding remains the best form of nutrition for infants. It provides natural insurance against the risk of allergy and common childhood infections. Nevertheless for many mothers who cannot, or choose not to breastfeed, this research claims that using formula milk enriched with prebiotic oligosaccharides can help boost their babies' resistance to common allergic reactions and infections (Anon, 2008).

1.8 Infant Formula:

The Federal Food, Drug, and Cosmetic Act (FFDCA) defines infant formula as "a food which purports to be or is represented for special dietary use solely as a food for infants by reason of its simulation of human milk or its suitability as a complete or partial substitute for human milk"(FDA, 2006). (Hediger et al., 2000; Ryan et al., 2002) found that in the United States and other industrialized countries, the majority of infants receive infant formula at some time during their first year of life as the number of infants breastfed after birth rapidly decreases (NAP, 2011).

1.8.1 Examples of Infant formula:

Iron supplemented formula milk (Aukett et al, 1999), Soya formulas, casein hydrolysate-based (Foster et al, 2004)

1.8.2 Advantage of Infant formula:

Replacing unmodified cows' milk with iron supplemented formula milk up to 18 months of age prevents iron deficiency anaemia in infants (Aukett et al, 1999). Iron supplemented formula milk reduces the decline in psychomotor development in infants from 6 months (Aukett et al, 1999). Infant formula sometimes contains prebiotics. These findings prove that the prebiotic Bimuno has a link to immune function and gut health in elderly people. Usually, the natural balance of bifidobacteria drops with age. Therefore this can leave older people more vulnerable to gastrointestinal disorders, colds and flu. Compared to probiotics which are live bacteria, the prebiotic Bimuno is a carbohydrate which is not destroyed. It is digested or absorbed in the stomach or small intestine. It thus reaches the colon intact to selectively target and feed the body's immunity boosting bacteria. At the same time, it lessens harmful bacteria. Lead researcher, Dr Jelena Vulevic, said: "This study proves that Bimuno not only reverses the decline in elderly people's health promoting bifidobacteria, but more significantly, shows that Bimuno has a direct effect on the body's immune defense cells thus enhancing immune function in elderly people" (Anon, 2009). The researchers in the Journal of Nutrition state that adding prebiotic oligosaccharides to infant formula may largely diminish the incidence of allergies and infections in newborn babies and young children. The advantages lasted long after the babies had stopped having formula and had been weaned. These effects were still obvious after two years. These results mention that an immune modulating effect through the intestinal flora modification may be the leading mechanism of action (Anon, 2008). Nan HA is a partially hydrolyzed nutritionally complete infant formula. It is an affordable, palatable and effective hypoallergenic infant formula available in the UK. It is for the feeding of healthy infants who are at susceptible to allergy and, whose mothers are unable to, or choose not to breastfeed. Short and long term studies of allergy prevention in high risk infants have shown that when Nan HA was used exclusively in non-breastfed infants, incidence of allergic diseases was lowered and cow's milk protein allergy declined by up to 50 per cent during the first three to five years of life, when compared with standard cow's milk formula or soy protein formula. Nan HA formula is adapted for new-born infants (Nan HA 1 starter formula) as well as for babies from 6 months (Nan HA 2 which is enriched with iron) (Anon, 2003).

1.8.3 Disadvantage of Infant formula:

Poorer health was observed among infant formula-fed infants (Dunstone et al, 2011). Goitre was seldom reported in infants consuming these formulas soya formulas as they were supplemented with iodine. Numerous cases of vitamin A deficiency were reported in the 1950s, among infants who were consuming certain soya formulas, casein hydrolysate-based or meat-based formulas. Also Skin lesions were famous among infants fed milk-based formulas with low levels of linoleic acid (Foster et al, 1997). Formula feeding is related to about a 20 to 30 percent greater likelihood that the child will become obese (NRDC, 2005).

1.9 Breast milk against Infant formula:

Breast milk is easily digested compared to Infant formula. (Maeda et al., 2001) explained that in terms of the easy digestion of human milk protein as well as effective absorption of human milk fat than infant formulae.(Singh, 2001) clarified digestibility in relation to the absence of a S1-casein and presence of greater proportions of unsaturated fatty acids in human milk than cow milk. (Gulliman et al, 2001) said that breast-fed infants are less like to become overweight during childhood compared to infant formula-fed infants. (lonnerdal, 1996) found that the higher amount of lactoferrin in Human milk enhances the absorption of iron compared to formulated milk. (Shehadeh et al., 2001) results showed that human milk contains insulin which acts as a barrier to diabetes compared to infant milk which lacks insulin (Sarkar, S., 2004). (Chierici et al, 1997) demonstrated that Infants fed with infant formulae failed to induce a prevalence of colonization with bifidobacteria. (Gori and Gudiel-Urbano, 2001) concluded that Formulae fed infants do not have non-digested oligosaccharides which can act as dietary fibre whereas breast-fed infants do have. Hence, breast milk contains certain components known as bifidus factors which help in the colonization of bifidobacteria in the intestinal tract of breast fed infants (Sarkar, S., 2004). Professor Moro's statement was as follows: "Although these oligosaccharides are not identical to those present in human milk, when added to formula milk and fed to pre-term and term babies they have been shown to result in softer and more frequent stools, and create an intestinal flora similar to that found in breast-fed infants" (Anon, 2008). Children who are exclusively breast-fed during the first three months of their lives are 34 percent less likely to develop juvenile, insulin-dependent diabetes compared to children who are fed formula (NRDC, 2005).

2.0 Complementary feeding:

The introduction of complementary feeding differs from one culture to the other. In some cultures, complements are given before the infant is three to four months of age. In others it is not given until the baby is six months old or even until the baby is one year old. But one should bear in mind that complementary feeding must begin at the right time together with the right type and amount of food to prevent malnutrition (Ogunbas, 2004). (Carson, 2006) recommends the introduction of solid food after 4 months of age.

2.2 Physiologic development of children:

According to (Mahan and Escott-Stump, 2008), the infant's birth weight is determined the length of gestation, the mother's pre-pregnancy weight and the mother's weight gain during gestation.

After birth the growth of an infant is determined by genetics and nourishment. Most infants who are genetically influenced to be larger reach their growth channel, a curve of weight and height or length gain throughout the period of growth between 3 to 6 months. However, many infants born at or below the tenth percentile for length may not reach their genetically growth channel until one year of age. This is called catch-up growth. (Smith et al., 1976) claimed that larger infants at birth who are genetically determined to be smaller grow at their fetal rate for several months and often do not reach their growth channel until 13 months.. This phenomenon during the first year of life is known as lag-down growth (Mahan and Escott-Stump, 2008).

Infants lose about 6% of their body weight during the first few days of life. They usually regain their birth weight by the seventh to tenth day. Growth therefore proceeds quickly but at a decelerating rate. Infants usually double their birth weight by 4 to 6 months of age and usually triple it at the age of 1 year. The amount of weight gain by the infant in the second year approximates the birth weight. Infants increase their length by 50% during the first year of life and double it by 4 years. Total body fat increases rapidly during the first 9 months after which the rate of fat gain tapers off throughout the rest of childhood. Total body water decreases from 70% at birth to 60% at 1 year. The decrease is almost all in extracellular water, which declines from 42% to at birth to 32% at the age of 1 year (Mahan and Escott-Stump, 2008).

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